COPD and Nutrients

I have had COPD since 2003. I quit smoking 6–7 years ago. I have tried many different inhalers, but Advair worked the best. Now, the Advair is no longer as effective. I was hoping you could suggest some nutrients that can help COPD.

ANNETTE, Omaha, NE

Dear Annette,

Figure 1. Changes in Forced Vital Capacity in one second (FEV1) with age in men. Changes in FEV1 are closely correlated with age and height.1
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First, you deserve a BIG “attagirl” for quitting smoking. Cigarettes are the most common (only?) cause of COPD, and quitting is the most important thing you could have done — and I know how tough overcoming that addiction is. Good job.

Unfortunately, COPD is not an “illness” that is easily treated. It is a chronic, progressive disease, that until recently was known to only become worse over time. To understand why, we need to understand normal lung changes with age (Fig. 1),1 and that COPD/emphysema is due to destruction of the tiny air sacs in the lungs, resulting in gaping holes (Fig. 2) with “air trapping” and a dramatic reduction in lung surface area (where the oxygen exchange takes place).

Combine the age-related decrease in pulmonary function with the anatomical changes due to COPD/emphysema and you can get an idea why COPD becomes worse over time, and why it is so difficult to treat effectively.

Figure 2. A. Normal lungs. B. COPD/Emphysematous lung, showing destruction of the alveoli.
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The standard treatments for COPD rely on bronchodilators and steroidal anti-inflammatory inhalers and systemic medications, as you are taking. Advair, of course, is a combination long-acting bronchodilator and synthetic corticosteroid. Although these drugs help to some degree, they do nothing to overcome the underlying destruction of the lungs, which has taken place.

N-acetylcysteine (NAC) has recently been recognized as a useful adjunct to “standard” treatment for COPD. NAC (1200 mg/day) used in conjunction with bronchodilators significantly enhanced the ability of the anti-muscarinic bronchodilator Atrovent to reduce functional residual capacity (FRC) (i.e., air trapping).2 Other studies showed that high-dose NAC improved small airway function3 and reduced the frequency and number of exacerbations of COPD per year.3–5 Although most of the studies used a maximum dose of 1200 mg per day, I recommend 1800–2400 mg per day for optimum effect.

Recently, a new approach has been developed which offers COPD sufferers some real hope, using the emerging field of stem cell therapy, with the patient’s own stem cells. The treatment is a one-day office procedure, in which the physician performs abdominal liposuction, from which the stem cells are separated. The stem cells are then suspended in a carrier solution, and injected intravenously into the patient. The stem cells travel through the bloodstream to the lungs, where they are “filtered” by the lungs — where the stem cells help to regenerate “new lungs.” This is a mind-blowing concept, but produces generally positive results. You can find more information about this procedure and physicians who are trained to perform it at www.stem.md.com. Within google type “copd stem cells site:https://www.md.com/” (without the quotes).

Hope this helps,

Ward Dean, MD

References

  1. Dean W. Biological Aging Measurement, Clinical Applications. Center for BioGerontology, Pensacola, FL, 1988.
  2. Sinojia R, Shaikh M, Kodgule R, et al. Priming of beta-2 agonist and antimuscarinic induced physiological responses induced by 1200 mg/day NAC in moderate to severe COPD patients: A pilot study. Respir Physiol Neurobiol. 2014 Jan 15;191:52-9.
  3. Tse HN, Raiteri L, Wong KY, et al. High-dose N-acetylcysteine in stable COPD: the 1-year, double-blind, randomized, placebo-controlled HIACE study. Chest. 2013 Jul;144 (1):106-18.
  4. Shen Y, Cai W, Lei S, Zhang Z. Effect of High/Low Dose N-Acetylcysteine on Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis. COPD. 2014 Jun;11(3):351-8.
  5. Tse HN, Raiteri L, Wong KY, et al. Benefits of high dose N-acetylcysteine to exacerbation-prone COPD patients. Chest. 2014 May 15. doi: 10.1378/chest.13-2784.

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